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Alveolar recruitment improves ventilatory efficiency of the lungs during anesthesia

[Le recrutement alvéolaire améliore l’efficacité ventilatoire des poumons pendant l’anesthésie]

Gerardo Tusman, MD^*, Stephan H. Böhm, MD, Fernando Suarez-Sipmann, MD and Elsio Turchetto, MD

^* From the Department of Anesthesiology and
Intensive Care Medicine, Hospital Privado de Comunidad, Mar del Plata, Argentina;
the Department of Anesthesiology, University Hospital; Hamburg-Eppendorf, Hamburg, Germany; and
the Department of Critical Care Medicine, Fundación Jimenez Díaz, Madrid, Spain.

Address correspondence to: Dr. Gerardo Tusman, Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina. Phone: +54-223-4990099; Fax: +54-223-4990099; E-mail: gtusman{at}hotmail.com

Purpose: The goal of this study was to analyze the effect of positive end-expiratory pressure (PEEP), with and without a lung recruitment maneuver, on dead space.

Methods: 16 anesthetized patients were sequentially studied in three steps: 1) without PEEP (ZEEP), 2) with 5 cm H₂O of PEEP and 3) with 5 cm H₂O of PEEP after an alveolar recruitment strategy (ARS). Ventilation was maintained constant. The single breath test of CO₂ (SBT-CO₂), arterial oxygenation, end-expiratory lung volume (EELV) and respiratory compliance were recorded every 30 min.

Results: Physiological dead space to tidal volume decreased after ARS (0.45 ± 0.01) compared with ZEEP (0.50 ± 0.07, P < 0.05) and PEEP (0.51 ± 0.06, P < 0.05). The elimination of CO₂ per breath increased during PEEP (25 ± 3.3 mL•min^–1) and ARS (27 ± 3.2 mL•min^–1) compared to ZEEP (23 ± 2.6 mL•min^–1, P < 0.05), although ARS showed larger values than PEEP (P < 0.05). Pa-etCO₂ difference was lower after recruitment (0.9 ± 0.5 kPa, P < 0.05) compared to ZEEP (1.1 ± 0.5 kPa) and PEEP (1.2 ± 0.5 kPa). Slope II increased after ARS (63 ± 11%/L, P < 0.05) compared with ZEEP (46 ± 7.7%/L) and PEEP (56 ± 10%/L). Slope III decreased significantly after recruitment (0.13 ± 0.07 1/L) compared with ZEEP (0.21 ± 0.11 1/L) and PEEP (0.18 ± 0.10 1/L). The angle between slope II and III decreased only after ARS. After lung recruitment, PaO₂, EELV, and compliance increased significantly compared with ZEEP and PEEP.

Conclusion: Lung recruitment improved the efficiency of ventilation in anesthetized patients.

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